53 OCEANSIDE DR - FENCE ,,)' ' '' '�Is , CITY OF ATLANTIC BEACH
_ 2 800 SEMINOLE ROAD
, tie. r)
j `- „r ATLANTIC BEACH, FL 32233
\ .=..--
/ INSPECTION PHONE LINE 247-5814
j- JJl9r-
FENCE PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-FNCE-2455
Job Type: FENCE PERMIT
Description: FENCE - REPLACEMENT
Estimated Value: $1,715.00
Issue Date: 10/28/2015
Expiration Date: 4/25/2016
PROPERTY ADDRESS:
Address: 53 OCEANSIDE DR
RE Number: 168846-5115
PROPERTY OWNER:
Name: SHIELDS, DAVID R & JANET C. *
Address: 53 OCEANSIDE DR
GENERAL CONTRACTOR INFORMATION:
Name: SUPERIOR FENCE AND RAIL OF NFL
Address: 5470 HIGHWAY AVE
Phone: 904-382-2221
PERMIT INFORMATION:
FEES:
Fence/ROW $35.00
Total Payments: $35.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
1 BUILDING CODES.
y
"Jr/�.# ..Vi
i•_"
I CITY OF ATLANTIC BEACH
'∎' 3 (OWNER / BUILDER AFFIDAVIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO TI-IAT
LAW. TILE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST
SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE—OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL,BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL, OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER 'TIE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(1). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826)IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
53 /2(. civised e d'i've f07.--2 VG _ZV 9/
ADD:ESS I PHONE NUMBER
1 So */.. /AI
PRINT
Lamf. .///._: /O /S /5--
SIG R'�•E DATE
Befo - e this t = —day of '- .204_'in the county of
Duva tate of Florida,has personally appeared herin by himself I herself and affirms that
all statements and declarations are true and accurate ,( )t/yl�/
Notary Public at Large,State of FL ,County of (,J(/V! (.�
f ❑Personally Known // - .
1 erorfucea Identification- .i. "'tip; DAVID EARL FLEISCHMANN
�r� � MY COMMISSION#FF157186
t!�- '•'.,?,r mod ` EXPIRES September 4,2018
Notary Signature_ — 007) -0t53 FloridallotaryService.com
r/BLDG/Owner-Builder Affidavit,REVISED.4/16!2009
LOGat.I MY,u a La vs.LVsst ".• —.
PROPERTY ADDRESS: 53 OCEANSIDE DRIVE ATLANTIC&EAif•. FLORIDA 32233 SJRvE'NUMI3Eit F.:3:3€ .t.t_
FIELD WORK DATE:3"7.-_ REVISION DATE(S?:vs.= ---'
91:J"'S
e 5 36.PG5 -2-72A
FL 1308.0443
BOUNDARY SURVEY ■040-=LA'"DG
.60•PR1VA?t RAM
DUVAL COUNTY N 89°37'21•E 50.07(`✓ --
r...? 0$ N 89°43'35'E 50.00'( ...f.,4-3::--
L I 5 89°43'35"W 50.00'(P) %"s . /III, c z
1III
589°44'I9"W49.98'(M) , a, •Mt -_ IIII 4
L2 5 89°43'35"W 65.00'(P) Btyl -404,004/7, .+ 1r
5 89°43'49"W 64.99'(M) w �����,, e
3 40 ` , �
�7r Af'►[AR9 TO>X°JOCVICIy)DY CrYY WATER AND 5[W`R
RACC oACc ONY NOT oICT RMtr� �gPI4 '(' i,I
:U-t.-;ACIC90NVIU.0 t.l1CrRIC AIJTt10RIN GASLTA[VT (`�
3� LOT 3 ►j?it �,;� Wk��
1,..,:n
r ri 3 5TY. of pe1.4 Oei n� q 1 AI k
o>3 Rts r53 '';��h gg c�I
3
. . �, �� (Q
o O- 5.5' 5.0' p#V b&
z z '. v 30.2 , Z
OZ ' --/IIIIII iII�yP∎$∎∎∎∎∎∎I
cn
,Nei) ' i , •IBYN C48 LBr'C<8 • ' I �� / "1*•.-.
L2 L r ;' /_
5 89°43'35"W 1 65.00'(P)
.010 B.HA,. 5 89°43'35'W 1 64.97'(M)
41 6.1.1 AltiAZ B.R. (PER PLAT) ^-
I hereby ■ tt t thl;i, Iptch of>• :t of the hereon ^- ' LOT i O
desai.-.p.perly,haeWi made u my direction,
and tothe,:, ONvie'dgeand.-tef,Itisatrue
and:• ra e •. ••, c• psurv:, at meets the
minimum L.. n aian : • 'set f. u the Florida
Board Of'Y-7..,.. T .turvey• ` described in A Chapter 5J- *., •Florida•• tive Code. 20 I G 2 8 4' 0 l 0 20-it SURVEj _Wesley B.Haas GRAPHIC SCALE Slate of Florida Proesional Surveyor and Mopper I rich = 20 feet �_
License No.3708
Use of This Survey for Purposes other than Intended,Without Written Verification,will be at the User's Sole Risk and Without Liability to the Surveyor.
• hereon shall be Construed to Give ANY Rights or Benefits to Anyone Other than those Certified.
FLOOD INFORMATION: POINTS OF INTEREST
BY PERFORMING A SEARCH WITH THE LOCAL GOVERNING (1)PAVER DRIVEWAY OVER 5'U.E.&D.E.(2)PAVER DRIVEWAY OVER
MUNICIPALITY OR WWW.FEMA.GOV,THE PROPERTY APPEARS TO BE 7.5'JACKSONVILLE ELECTRIC AUTHORITY EASEMENT
LOCATED IN ZONE X.THIS PROPERTY WAS FOUND IN THE CITY OF
ATLANTIC BEACH,COMMUNITY NUMBER 12(X)75,DATED 06/03/13.
Florida Land AFFILIATE
CLIENT NUMBER:RS13-1619 I DATE: 8/7/2013 Title Association
BUYER ELIZABETH C SAMS AND JONATHAN H JACOBS FETA
MEMBERS
SELLER:DAVID R SHEILDS AND JANET C SHIELDS
i CERTIFIED TO:ELIZABETH
FFICES OF ROD SCHLOTH;OLD REPUBLIC NATIONAL LAW E
TITLE INSURANCE COMPANY;SWBC MORTGAGE CORP
Land Surveyors, Inc. 73:,..'"'"° `�:n`.
A BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904)247-5845 �,5 - 1-- N CC-Z 4 r_;
Job Address: 5-3 D/ek side --. ,,,•y a Permit Number:
Legal Description Parcel#
Valuation of Work$ / i- S Proposed Work Work he ted/cooled t
non-heated/cooled
Class of Work(circle one): New Additio Alteratio Repair Move Demolition pool/spa window/door
Use of existing/proposed structures)(circle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
Florida Product Approval#
For multiple products use pro uct approva orm
Describe in detail the type of work to be performed: •. _ . - ,
{PJh� t with w l `ic '�'a Vie Kivt c �.0 ' f - /u�i�
Ge . 74 �� 6 T 'l-C/Ve d8 l eat?citel' d?1 Sv,"v r�
Property Owner Information: /
Name: a7d- /h 6.i■»15 f ei J tAddress: 53 dLedAIS ae -)ei Ve
City 4f"f,14 ,2 State/_Zip 32233 Phone 90 5/-?y6 - ZYp/
E-Mail or Fax#(Optional) e l i Z2 ite-+, .5 1641524 ®l w1A.;I. 4.15)14
Contractor Information: CONTRACTOR EMAIL ADDRESS:-7)4v id F(, sup er.;o r Few ava rd-;I tes-,z,
Company Name: S. pedi p r F vice I- t
Address: S'�7 }.<<C$t�w� Av�P,vl_ve Qualifying Agent: �av�a FIPaS� vvtdtrtn
Office Phone �b� - (�$3 L 3 y 9 Job Site/Con Clty ��Sa>7��l i e State Fl. Zip 3ZI S�}
State Certification/Registration# Contact Number 9a yz• p ZZ J Fax# 9a y-G g 3 ��
Architect Name&Phone# A
Engineer's Name&Phone# VIM
Fee Simple Title Holder Name and Address A JF
Bonding Company Name and Address
Mortgage Lender Name and Address
issuance fa is and hat allbwok will be pe fo the d towork
meet the installations d of as all laws regulatinng that struc ion in hiinstallation jurisdiction.aThis permit becomes prior null the
and void f work is not commenced within six(6)months,or if construction or work is suspended or abandoned for a__period of six(6)months at any time after
work is commenced I understand that separate permits must be secured for Electrical 'York,Plumbing,Signs, Wells,Pools,Furnaces,Boilers,Heaters,
Tanks and Air Conditioners,etc.
t
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereby certifi,that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
ype of work will be complied with whether specified erein or not. The granting of a permit does not presume to give authority to violate or cancel the
)rovisions of any other federal, . t, ,r local law re !acing construction or the performance of construction.
signature of Owner /,, /A�� ni ii ! Signature of Contractor2 2 ?A
mis
'tint Name /�
1 I ` 1 -t 7 � 5 Print Name 269(fI f Or-)
tefore a Befor
lisi Day of ,20-I :�
this �S of 4� .x,,. RLFLEIS Ai
' r�.7r� •; ::''':.,0.1.4r,
. MY •. . • .
= YID EARL FLEISCNMANN
-otary Pu•'is •f , • MY COMMISSION#FF157186 �� _ _O�: EXPIRES September 4,2018
!��� ' N: ��' r IIC 10 159 FbridallotaryService.com
k,�;,:ces EXPIRES September 4,2018 1 >)
(407)99 -0153 Floridallotaryservice.com Revised 01.26.10 1
as-�vr� City of Atlantic Beach APPLICATION NUMBER
Js � Building Department (To be assigned by the Building Department.)
A 1 800 Seminole Road
; Atlantic Beach, Florida 32233-5445 rj— �— IV - M �J
Phone(904)247-5826 Fax(904)247-5845
's... E-mail: building-dept @coab.us Date routed: I v fir
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 5,.3 O 4 J(2_ Department review required Yes No
Buildin
Applicant: Su p&R t 0 F� �c.E RA( L- &Zoning
Tree1—
Project: Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: Approved. ['Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: !/ ,V Date: Ia/2.O�f
TREE ADMIN.
Second Review: ❑Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10